Lee SooJin, Baek KyungWon, Chun Kihong
Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Korea.
Division of Social Welfare, Baekseok University, Cheonan, Korea.
Yonsei Med J. 2014 Nov;55(6):1533-41. doi: 10.3349/ymj.2014.55.6.1533.
The aim of this study was to evaluate the cost-effectiveness of the use of drug-eluting stents (DESs), as compared with bare-metal stents (BMSs) in Korea.
A retrospective cohort study was conducted between January 2000 and December 2007. Subjects were stent-treated for the first time between 2004 and 2005, with four years of follow-up (2004-2007) (n=43674). The incremental cost-effectiveness ratio (ICER) was used to calculate the costs of DESs compared with BMSs among patients with coronary artery disease (CAD). Cost-effectiveness was assessed with effectiveness defined as a reduction in major adverse cardiac events after six months and after one, two, three, and four years.
The total costs of a DESs were 674108 Korean won (KRW) higher than that of a BMSs at the end of the follow-up; 13635 thousand KRW per patient treated with DESs and 12960 thousand KRW per patient treated with BMSs. The ICER was 256315 per KRW/death avoided and 293090 per KRW/re-stenting avoided among the CAD patients at the end of the follow-up.
The ICER for the high-risk patients was lower than that for the low-risk patients. The use of DESs is clinically more useful than the use of BMSs for CAD and myocardial infarction patients, especially for those considered to be high-risk patients in Korea.
本研究旨在评估在韩国使用药物洗脱支架（DES）与裸金属支架（BMS）相比的成本效益。
进行了一项回顾性队列研究，时间跨度为2000年1月至2007年12月。研究对象于2004年至2005年首次接受支架治疗，并进行了四年的随访（2004 - 2007年）（n = 43674）。采用增量成本效益比（ICER）来计算冠心病（CAD）患者中DES与BMS相比的成本。成本效益评估的有效性定义为六个月后以及一、二、三、四年后主要不良心脏事件的减少。
随访结束时，DES的总成本比BMS高674108韩元；接受DES治疗的患者人均成本为1363.5万韩元，接受BMS治疗的患者人均成本为1296.0万韩元。随访结束时，CAD患者中ICER为每避免一例死亡256315韩元，每避免一次再植入为293090韩元。
高危患者的ICER低于低危患者。对于CAD和心肌梗死患者，尤其是韩国被认为是高危的患者，使用DES在临床上比使用BMS更有用。
